# Fantastic stewards and where to find them: a descriptive study of the heterogeneous disparity in physician–pharmacist–nurse distribution among the infectious disease workforce

## TL;DR

This study examines how infectious disease professionals are distributed in Japan, revealing significant regional disparities.

## Contribution

The study provides new insights into the geographical disparity of infectious disease professionals in Japan using a descriptive cross-sectional approach.

## Key findings

- ID physicians showed the highest inequality in distribution (Gini coefficient 0.46) compared to pharmacists and nurses.
- Over half of the SMAs had at least one professional from each group, while 3.9% lacked all three.
- Workforce density per unit area was strongly correlated across the three professional groups.

## Abstract

Infectious disease (ID) care involves a diverse range of professionals, yet the shortage and geographical disparity of ID physicians, among other professionals, remain underexplored. This cross-sectional descriptive study aimed to elucidate the distribution of ID physicians, infection control (IC) pharmacists, and IC nurses in Japan, focusing on the interrelations among the ID workforce within medically relevant geographical units.

Publicly available data from 335 secondary medical areas (SMAs) in Japan, with a population of 125 million, were analyzed. Workforce distribution was assessed using the Gini index to quantify inequalities and spatial clustering across the SMAs per capita, per hospital bed, and per unit area. χ2 test was used to assess the association of hospital characteristics with the presence of each professional.

The research subjects were 1,729 ID physicians, 1,371 IC pharmacists, and 2,657 IC nurses, whose workplace data were available in Japan as of 2023. The Gini coefficients for the densities of ID physicians, IC pharmacists, and IC nurses per 100,000 people were 0.46, 0.34, and 0.28, respectively. The density of the ID workforce per unit area (1,000 km2) showed a positive correlation ( > 0.8) with any combination of ID physicians, IC pharmacists, and IC nurses. A total of 186 SMAs (56%) had at least one member from each professional group and 13 (3.9%) lacked staff from all three.

The substantial variation in ID workforce composition across SMAs suggests opportunities for both regional and national policy and identifies new avenues for improving access to ID care.